Provider Demographics
NPI:1619053261
Name:NICHOLS, RALPH E R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:E R
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6539 E 31ST ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1242
Mailing Address - Country:US
Mailing Address - Phone:918-828-9707
Mailing Address - Fax:918-828-9706
Practice Address - Street 1:6539 E 31ST ST
Practice Address - Street 2:SUITE 8
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1242
Practice Address - Country:US
Practice Address - Phone:918-828-9707
Practice Address - Fax:918-828-9706
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical